Macular Degeneration: Dry vs. Wet ? Avastin -Lucentis – Aflibercept injections

Macular Degeneration: What is it and what can I do about it ?

Macular degeneration is a damage to the retina.  If the eye was a camera, the retina is the film.  Increasing damage to the retina equals decreasing vision. Wet macular degeneration has leaky blood vessels where Dry macular degeneration is more a deterioration.   This page will review Macular Degeneration: Dry vs. Wet ? Avastin -Lucentis – Aflibercept injections

A normal retina looks like this:

The center of the retina is called the MACULA.  It is where our best vision is located. If the macula is damaged we lose our ability to see fine detail for both reading and distance.  Macular disease often affects reading first because letters are small and distance later because cars, buildings are bigger than printed text.

Macular degeneration has two forms:

  1. Dry Macular Degeneration: no leaking blood vessels
  2. Wet Macular Degeneration: presence of leaking blood vessels

DRY MACULAR DEGENERATION:

Early Dry Macular Degeneration:

The pigment color changes in the center are abnormal

SEVERE DRY AGE RELATED MACULAR DEGENERATION:

There are severe pigmentary changes in the retina.  The greater the pigmentary change the worse the vision.

ATROPHY OF MACULA:

Note the absence of the smooth velvety orange of the central retina area with exposure of the yellow underlying choroid. The retina is missing.  Vision will be quite poor.  Reading is most likely nearly impossible.

WET MACULAR DEGENERATION:

Presence of leaking blood vessels.

TESTING:

  1. Amsler Grid

  2. Flourescein Angiography

  3. OCT

Amsler Grid:

Changes in the retina can be very subtle.  Dr. Duplessie may have you look at some boxes with straight lines to evaluate your retina, which is called an Amsler grid.

FLOURESCEIN ANGIOGRAPHY [DYE TEST]:

Fluorescein angiography is a study of the retina and macular to look for  retinal vascular disease or abnormal blood vessels.

How Is the Test Performed?

Your eyes will be dilated and a very special camera will be used to photograph your retina after you receive a small injection of flourescein dye.

What Are the Risks of the Test?

The most common reaction is irritation around the area where the flourescein was injected in your arm.

There can be a brief feeling of nausea and rarely vomiting. Other possible side effects include dry mouth, increased salivation, increased heart rate, and sneezing. In rare cases, you may have a serious allergic reaction, which can include the following:

  • swelling of the larynx
  • hives
  • difficulty breathing
  • fainting
  • cardiac arrest

Please tell Dr. Duplessie if you are pregnant. While the risks to the fetus are unknown, we do not offer this test to pregnant women.

Understanding the Results

Normal Flourescein Results

If your eye is healthy, the blood vessels will have normal shape and size. There will be no blockages or leaks in the vessels.

Abnormal Flourescein Results

Abnormal results will reveal a leak or blockage in the blood vessels. The glowing vessels in the center of the picture below are abnormal.

OCT

NORMAL RETINAL OCT

ABNORMAL RETINAL FLOURESCEIN AND OCT:

More information equals better treatment

Early diagnosis is possible with the OCT.  The subtle changes of macular degeneration noted below may not have been appreciated in a normal examination.

Better technology equals early diagnosis and earlier treatment.

Treatment of Macular Degeneration: Avastin -Lucentis – Aflibercept injections

Drugs Avastin and Lucentis. Pictured at Queen Marry Hospital, Pok Fu Lam. 23APR10
  1. Avastin –

  2. Lucentis –

  3. Aflibercept:

LUCENTIS, Avastin and Aflibercept are all intra-ocular injections indicated for the treatment of patients with neovascular (wet) age-related macular degeneration (wAMD).  Study after study has shown them to work equally well.

The primary difference is cost.  No one compound has proved superior to another.

Dr. Duplessie is delighted to review all the major studies with you.  They can be easily all found online.